KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Research Roundup: Impact Of Early Medicaid Expansion

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions 
Since 2010, California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the [health] law's option to expand coverage earlier to a portion of low-income childless adults. ... Using administrative records, we documented that the ramp-up of enrollment was gradual and linear over time in California, Connecticut, and D.C. Enrollment continued to increase steadily for nearly three years in the two states with the earliest expansions. ... Medicaid enrollment rates were highest among people with health-related limitations. We found evidence of some crowd-out of private coverage in Connecticut (30–40 percent of the increase in Medicaid coverage), particularly for healthier and younger adults (Sommers, Kenney and Epstein, 1/6).

Kaiser Family Foundation: State Profiles: How Will The Uninsured Fare Under The Affordable Care Act?
The state-level reports serve as a guide to the potential impact of the ACA in each state and the District of Columbia as legislatures begin to convene and governors prepare their budget proposals and state-of-the-state addresses. Based on analysis by Kaiser researchers, each state report provides a breakdown of how many uninsured people are eligible for Medicaid or for financial assistance to help them buy private insurance in the new Marketplace, and how many may gain new coverage but will not receive any financial assistance. Each report also details the income levels at which people in each state are eligible for Medicaid or financial assistance in the Marketplace. For states not expanding Medicaid, each report quantifies how many uninsured people with incomes below the poverty level fall into the "coverage gap" and will be ineligible for financial assistance in the Marketplace or for Medicaid in their state (1/6).

Health Affairs: Analysis Of Early Accountable Care Organizations Defines Patient, Structural, Cost, And Quality-Of-Care Characteristics
Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. ... We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics (Epstein et al., 1/6).

JAMA Pediatrics: A Statewide Medicaid Enhanced Prenatal Care Program 
Data, including birth records, Medicaid claims, and monthly program participation, were extracted from the Michigan Department of Community Health warehouse. Participants included all 60 653 pregnant women who had a Medicaid-insured singleton birth between January 1 and December 31, 2010, in Michigan. The [Maternal Infant Health Program] MIHP participants were propensity score-matched with nonparticipants ...  Participation in MIHP reduced the risk for adverse birth outcomes in a diverse, disadvantaged population. The study adds to the evidence base for enhanced prenatal care home visiting programs and informs state and federal investments (Roman et al., 1/6).

JAMA Internal Medicine: Rapid Increase In Breast Magnetic Resonance Imaging Use Trends From 2000 To 2011 
Breast magnetic resonance imaging (MRI) is highly sensitive for detecting breast cancer. Low specificity, cost, and little evidence regarding mortality benefits, however, limit recommendations for its use to high-risk women. ... Breast MRI use increased more than 20-fold from 6.5 per 10,000 women in 2000 to 130.7 per 10 000 in 2009. Use then declined and stabilized to 104.8 per 10,000 by 2011.  ... most women receiving screening and surveillance breast MRIs lacked documented evidence of meeting [American Cancer Society] criteria, and many women with mutations were not screened. Efforts are needed to ensure that breast MRI use and documentation are focused on those women who will benefit most (Stout et al., 1/6).

JAMA Surgery: Explaining Racial Disparities In Outcomes After Cardiac Surgery: The Role Of Hospital Quality
Racial disparities in mortality rates after coronary artery bypass graft (CABG) surgery are well established. We have yet to fully understand how care at high-mortality, low-quality hospitals contributes to racial disparities in surgical outcomes. ... Nonwhite patients had 33% higher risk-adjusted mortality rates after CABG surgery than white patients. In hospitals treating the highest proportion of nonwhite patients, the mortality was 4.8% in nonwhite and 3.8% in white patients. When assessed independently, differences in hospital quality explained 35% of the observed disparity in mortality rates. We were able to explain 53% of the observed disparity after adjusting for differences in socioeconomic status and hospital quality. However, even after these factors were taken into account, nonwhite patients had a 16% higher mortality (Rangrass, Ghaferi and Dimick, 1/8).

JAMA Neurology: Disparities In Access To Deep Brain Stimulation Surgery For Parkinson Disease  
Despite the fact that African American patients are more often discharged from hospitals with characteristics predicting [deep brain stimulation (DBS) use to treat Parkinson disease], these patients received disproportionately fewer DBS procedures compared with their non–African American counterparts. Increased reliance on Medicaid in the African American population may predispose to the DBS use disparity. Various other factors may be responsible, including disparities in access to care, cultural biases or beliefs, and/or socioeconomic status (Chan et al., 1/6). 

JAMA Psychiatry: Accuracy Of Reports Of Lifetime Mental And Physical Disorders
Our understanding of how mental and physical disorders are associated and contribute to health outcomes in populations depends on accurate ascertainment of the history of these disorders. Recent studies have identified substantial discrepancies in the prevalence of mental disorders among adolescents and young adults depending on whether the estimates are based on retrospective reports or multiple assessments over time. ... [Researchers analyzed] Prospective population-based survey (Baltimore Epidemiologic Catchment Area Survey) with 4 waves of interviews of 1071 community residents in Baltimore, Maryland, between 1981 and 2005. ... One-time, cross-sectional population surveys may consistently underestimate the lifetime prevalence of mental disorders. The population burden of mental disorders may therefore be substantially higher than previously appreciated (Takayanagi, 1/8).

JAMA Internal Medicine: Obesity And Late-Age Survival Without Major Disease Or Disability In Older Women 
The effect of obesity on late-age survival in women without disease or disability is unknown. ... Examination of 36,611 women from the Women’s Health Initiative observational study and clinical trial programs. ... Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. ... Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability (Rillamas-Sun et al., 1/6).

Georgetown University Health Policy Institute/Kaiser Family Foundation: Medical Debt Among People With Health Insurance
An estimated 1 in 3 Americans report having difficulty paying their medical bills .... While the chances of falling into medical debt are greater for people who are uninsured, most people who experience difficulty paying medical bills have health insurance. ... People with unaffordable medical bills report higher rates of other problems – including difficulty affording housing and other basic necessities, credit card debt, bankruptcy, and barriers accessing health care. This report examines medical debt through case studies of nearly two dozen people who recently experienced such problems, and reviews their experiences in light of other studies and surveys about medical debt (Pollitz, Cox, Lucia and Keith, 1/7).

Kaiser Family Foundation: Health And Access To Care And Coverage For Lesbian, Gay, Bisexual, And Transgender Individuals In The U.S. 
The ACA expands access to health insurance coverage for millions, including [lesbian, gay, bisexual, and transgender] individuals, and includes specific protections related to sexual orientation and gender identity. The Supreme Court ruling on [Defense of Marriage Act] resulted in federal recognition of same-sex marriages for the first time, which also serves to provide new health insurance coverage options. In addition, President Obama's administration has undertaken a variety of other initiatives to improve the health and well-being of LGBT individuals, families, and communities (Ranji, Beamesderfer, Kates and Salganicoff, 1/8).

Journal of Interpersonal Violence: Prevalence Of Substance Use And Intimate Partner Violence In A Sample Of A/PI MSM
This study evaluates the prevalence of three forms of intimate partner violence (IPV) (i.e., experience of physical, psychological/symbolic, and sexual battering) among a national sample of Asian/Pacific Islander (A/PI) men who have sex with men (MSM) in the United States. ... The present findings suggest that individuals with a history of IPV in the past 5 years were more likely to report substance use (33.6%) compared to those without a history of IPV experience (16.1%). (Tran et al., 1/3).

Here is a selection of news coverage of other recent research:

Reuters: PepsiCo's Workplace Wellness Program Fails The Bottom Line
Released on Monday in the journal Health Affairs and based on data for thousands of PepsiCo employees over seven years, the findings "cast doubt on the widely held belief" that workplace wellness programs save employers significantly more than they cost. ... PepsiCo's "Healthy Living" program ... has two components. One, called disease management, helps people with any of 10 chronic illnesses, among them asthma, diabetes and hypertension. They receive regular phone conversations with a nurse about managing the condition. Disease management produced healthcare savings of $136 per member per month, largely because of a 29 percent reduction in hospital admissions (Begley, 1/6).

NPR: Drinking Too Much? Don't Count On Your Doctor To Ask
Most of the people who have problems with drinking aren't alcoholics, and having a brief chat with a doctor is often all it takes to prompt excessive drinkers to cut back. But, it turns out, doctors aren't bringing the topic up. More than 80 percent of adults say they've never discussed alcohol use with a health professional, a survey finds. Young people and binge drinkers were most likely to be asked about alcohol use, according to a survey by the Centers for Disease Control and Prevention (Shute, 1/6).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.